Anatomy scan

Archived User

Anatomy scan

September 11, 2006 02:05 AM

Hi, I'm 27 years old, 16 weeks pregnant and currently trying to
weigh up the benefits and risks of the 19-week ultrasound. I chose
against any first trimester screening, but am finding this decision
more difficult. I'm partly concerned about the unknown effects of
ultrasound and partly just don't "feel like it". I mean, I'm
enjoying getting to know my baby myself and am worried relying on
ultrasound to "see" my baby might stain the beauty of using my
intuition. However, I realise the the scan might be beneficial in
picking up e.g. spina bifida, which then would influence me to
choose a different birthing plan. So I'm just putting the word out
there to ask others about their thoughts and feelings on the
benefits and risks of this scan? Thanks By: azima

Archived User

I'll weigh in for starters. When having any test, one must consider
its potential harms vs potential benefits, and its accuracy. One
must also consider whether one intends to take any action based on
test results. If the answer to the last question is "no," then stop
right there. The rule is: Don't have the test.

One benefit that you have listed is that the discovery of a neural
tube defect would change your plans for the birth. I'm not sure
what that change of plans might be, but if that is your only
concern, why not just take a quick peek in the 3rd trimester?
That's plenty of time to decide that you will have your baby in the
hospital instead of at home or in a free-standing birth center and
whether the condition is serious enough to warrant planning a
c/sec. (Neural tube defects, you should know, are not a black &
white issue. They can range from extremely minor to severe, as can,
no doubt, other congenital anomalies.)

On the minus side, you have articulated a concern that is on the
money: "getting to know the baby." If you would not end the
pregnancy based on what is shown on the ultrasound, you will have,
as the Dutch call it, "spoiled the pregnancy." You will almost
certainly spend the rest of the pregnancy in anxiety, distress, and
grieving for something that cannot be treated until the baby is
born. But there is worse: Ultrasound scans not infrequently give
ambiguous news or even an erroneous diagnosis. Then you will not
only worry your way through the rest of the pregnancy for nothing,
but studies have shown that even after the baby is born and shown
to be healthy, women may continue to worry that all is not well
with their child. A mother who is unduly anxious and hypervigilant
about her baby is going to be a different sort of mother from one
who is not, and that could have subtle, yet powerful, consequences
for their relationship.

As for potential harms of exposing the unborn baby to ultrasound in
the 2nd trimester, I haven't researched this recently, but I would
think that the odds are that risk of harm would be minimal with a
single abdominal scan after the 1st trimester. It's hard to prove a
negative, though. There is always the possibility that if the study
measured something else or used a bigger population, it might
detect an association. What I would do in your shoes if I were
going ahead with the scan is:

-- To ensure greatest accuracy and reliability of diagnosis, have
the scan done by a certified sonographer in a facility that
specializes in imaging or a hospital imaging department. Don't just
have your ob do it in the office. Ask for the qualifications of the
person doing the scan and the person reading it. Don't assume;
unless things have changed fairly recently, unlike, say, your
hairdresser, there are no regulations regarding training and
experience for ultrasonographers. Obstetricians can be "trained" as
part of a weekend cruise junket.

-- Discuss what, specifically, you want to know because knowing it
could influence your plans. Then find out how to get the briefest
possible exposure that will find those things out. In other words,
don't agree to a fishing expedition of whatever length and exposure
is the usual protocol.

-- Discuss whether an abdominal scan is ordered, where the probe is
moved across your belly, or a vaginal scan, where the probe is
inserted vaginally. For one thing, there may be a difference in
risk since the probe is inches from the baby with very little in
between. Also, some women have bluntly described a vaginal scan as
"rape with a foreign object." Certainly, if you have sexual assault
or abuse in your past, I would leery of agreeing to a vaginal scan.
At the very least, you don't want any surprises on this point.

Henci

By: Henci Goer

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